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Effectsofglucoseonthebrain
Creators:ShamikMukherji,AlanJacobson
Thoughthereisagreatamountofattentiongiventotheeffectsofdiabetesontheperipheralnervoussystem,itisimportant
nottooverlookthediseaseseffectsonourbrains.Whileotherorgansinthebodymayrelyonalternativesourcesofenergy,
suchasfattyacids,thebrainreliesalmostsolelyonglucose,usingketonesasalastresort.Forthisreason,thebloodbrain
barrierisrichinGlut1activeglucosetransporters,andover99%oftheglucosethatpassesitisusedbyneuronsandglia.
Thus,themetabolicefficiencyandcontinuousdemandsofthebrainrenderituniquelysusceptibletofluctuationsinglucose
concentrationinthebody.
Aswediscussinthischapter,hyperglycemiaandhypoglycemiabothcanhavedetrimentaleffectsoncognitionaswellas
mood.TheseeffectsareevidentinpeoplewithType1andType2diabetes.Themostcommonmanifestationsofcognitive
deficitareneuralslowing,attentiondeficit,andexecutivefunctioning.Patientswithtype2diabetesinparticulardomorepoorly
inmeasuresoflearningandmemory[1].
Itisimportanttonotethatinahospitalsettingpatientswithoutdiabetescanbecomehyperglycemic,andthesepatientshave
anincreasedmortalityrisk[2].Stressinducedhyperglycemiainpatientswithoutdiabetescanoccurduringperiodsofacute
illnessandmaybeduetohormonalcascades,particularlyincreasesinepinephrine,cortisol,growthhormoneandglucagon[3].
Patientsmayhaveprediabetes,ormayhavefrankdiabetesthatisundiagnosed.Amonghyperglycemicpatientsingeneral
medicinewards,onestudyfoundthat12%wereundiagnosed,andthattheyhad18.3timesthemortalityrateoftheir
normoglycemicpeers.Thesepatientsalsohadlongerhospitalstays,wereadmittedtotheICUmoreoften,andlargelyhad
theirhyperglycemiauntreatedthroughoutthecourseoftheirstay[4].Similarly,inpatientsbothwithandwithoutdiabetes,
hypoglycemiaisassociatedwithincreasedinpatientmortalityandincreasedhospitallengthofstay[5][6].
Aclinicalawarenessofapatientsglycemicstate,especiallyifthepersonhasdiabetes,iskeytoprotectinghigherneurological
functioning,suchasmoodandcognition,aswellasmitigatingtheriskofmortality.Inthischapter,wewillfurtherdiscussthe
acuteandchroniceffectsofbothhypoglycemiaandhyperglycemiaonthebrain.
AcuteHyperglycemia
Theeffectsofacutehyperglycemiaonmoodandcognitioninpeoplewithdiabetesarecontroversial.Onestudyshowedthat
peoplewithtype2diabetesmaynotexhibitchangesincognitionormoodinshortperiodsofmildhyperglycemia.Interestingly,
patientsmayreportfeelingsofwellbeingandlessangerduringperiodsofbriefmildhyperglycemia[7].Otherresearch
contradictsthis,reportingincreasedirritabilityanddecreasedfeelingsofwellbeinginpeoplewithtype1andtype2diabetes
whoareacutelyhyperglycemic[8][9].Itappearsthatglucoselevelandnotvariabilityisthedeterminantofmoodvariation[9].
Patientswithlowerpostprandialglucose,however,dobetterthanthosewithhigherpostprandialglucoseincognitivetesting
[10].
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Inpragmaticstudiesinvolvingpeoplewithdiabeteswhosedrivingabilitiesareassessed,acutehyperglycemiacanleadto
tirednessanddecreasedvisualacuity.Thiscanthencauseincorrecttreatmentadjustmentprecipitatinghypoglycemia[11].
Peoplewithtype1diabeteshavebeenshowntohavelowerverbalandoverallIQscoresduringperiodsofacute
hyperglycemia[12].BothpeoplewithType1andType2diabeteshaveexhibitedlowercognitivescoreswhenbloodglucose
increasespast15mmol/l[13].Thus,acutehyperglycemiaappearstohavedetrimentaleffectsthatmayperturbdaytoday
functionsofbothpeoplewithType1andType2diabetes.
ChronicHyperglycemia
Theeffectsofchronichyperglycemiaaremorepronouncedthanthoseofacutehyperglycemia.Longtermhyperglycemiaas
seeninpeoplewithdiabetesappearstoresultinsignificantchangesintheirmoodandcognitivestate.Forinstance,type2
diabetesisbidirectionallyassociatedwithdepression[14].Indeed,peoplewithtype2diabeteswhohaveahemoglobinHbA1c
withinthenormalnondiabeticrangeexhibitfewersymptomsofdepressionthanthosewithhighHbA1c[15].
Peoplewithtype1diabetesperformsignificantlyworsethantheirnondiabeticpeersinattention,psychomotorefficiency,
cognitiveflexibility,andgeneralintelligence[16].Theetiologyoftheseeffectsisunclear,andisthesourceofmuchresearch.
StudieshavefoundthathighHbA1clevelspredictcognitivedeficitanditsdevelopmentovertimeinpatientswithandwithout
diabetes[17].Hyperglycemiaandadiposityareassociatedwithpoorcognitivefunctioninginmiddleagedpeoplewithout
diabetesaswell,whichshowsthatthesefactorsindependentlyaffectcognitivefunctioningoutsideoftheusualcomplications
ofdiabetes[18].Childrenwithtype1diabetesmayhavepoorerworkingmemoryasaresultofhyperglycemia.Childrenwith
multipleriskfactors,ofwhichhyperglycemiawasone,appearedtodoworseintestsofverbalabilities,workingmemory,and
mentalefficiency.Childrenwithotherriskfactors,suchasearlieronsetdiabetesandhypoglycemia,inconjunctionwith
hyperglycemia,didworsethanpeersinthesametests.Chronichyperglycemiaincreasestheriskofcognitivedeclineinthose
withdiabetesby60100%.ThisisprimarilyduetoahigherriskofvasculardementiaratherthanthatofAlzheimersdisease
[19].TheriskofAlzheimersdiseaseinpeoplewithdiabetes,however,iselevatedaswell[20].Thereisa50100%increased
riskofstrokeinpeoplewithdiabetesversusanormalpopulation,withastrokerelativeriskof1.15(95%CI1.081.23)for
every1%(11mmol/mol)riseinHbA1c[21].Theetiologyofthisisunderstudy.Endocrineabnormalities,suchaschangesin
insulinandamyloidmetabolism,andincreasedoxidativestressmaybeatfault.Inflammatoryphenomena,evidencedbyan
increaseinCRP,IL6,andTNfconcentration,havebeenstudiedinrelationtothisphenomenonaswell[22].
ArterialspinlabelingMRIstudieshaveshownthatcerebralbloodflowispoorerinpeoplewithdiabetes,andthatthesepeople
exhibitsignsofcorticalandsubcorticalatrophy[23].Lacunarinfarctsoccurmorefrequentlyinpeoplewithdiabetes,andthereis
asignificantassociationbetweencognitivedysfunction,lacunarinfarcts,andtheirprevalenceindiabetes[24].Hippocampal
atrophymaybeanothercauseofcognitivedysfunction,asitsdegreeispredictedbyHbA1c.A1015%lossinhippocampal
volumehasbeendocumentedintheelderlywithprediabetes,andisassociatedwithmemoryimpairments[25].The
hippocampusishighlyvulnerabletohypoglycemicdamage,aswouldbeexpectedinpeoplewithType1diabetes,however,
studiesshowthatcorticalatrophyinthehippocampusismorepronouncedinthosewithType2diabetes.Thismaybebecause
peoplewithType2diabetesareolderonaveragethanpeoplewithType1diabetes[26][27].Thereasonsfortheincreasedrisk
ofdementiaand/orcognitivedeficitinthosewithdiabetesmayultimatelybemultifactorial.
AcuteHypoglycemia
Despitetheconflictingevidenceregardingtheeffectsofrecurrentepisodesofhypoglycemiaonthebrain,itisgenerally
acceptedthathypoglycemiacausesneuronalinjuryandimpairmentsinmoodandcognition[28][29].Moderateepisodesof
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hypoglycemiahavebeenshowntocauseshorttermcognitivedeficits,whichincreasetheriskofmotorvehicleaccidents[29].
InavehicledrivingstudyonpeoplewithType1diabetes,cognitionwasshowntoreturntobaselineuponreturntoeuglycemia
[30].Thelengthoftimeittakesforonetorecovercognitivelyfromhypoglycemicepisodeisamatterofdebateandmaybe
relatedtotheseverityofthehypoglycemia.Cognitiverecoverymaytakeseveraldaysinthosewhohaveexperiencedsevere
hypoglycemia[31][32].Inhealthypeoplewithoutdiabetes,acuteepisodesofhypoglycemiacausefeelingsoftirednessand
increasedtension[33].InpeoplewithType1diabetes,acutehypoglycemiacausesdeficitsincognitivetaskcompletion,
increasedanxiety,anddecreasedenergy[34].
Thereisevidencethatanextendedepisodeofseverehypoglycemiacausesdirectneuronalnecrosis[35].Thebrains
metabolismitselfchangesafterrepeatedepisodesofhypoglycemiainashortamountoftime.Hypoglycemicepisodeswithin
1224hofeachotherresultinasuppressionofcounterregulatoryresponsestosubsequenthypoglycemicepisodes[36].Asthis
isfoundinbothtype1andtype2diabetes,itmayalsobeanadaptivemechanismbywhichthebrainbetterresistsfurther
hypoglycemicinsult,andmaybeexpressedevenatthecellularlevel[37][38][39].However,thisincreasesthepatientsriskof
subsequenthypoglycemia.Thepatientsawarenessoftheirownsymptoms,asaresultofthesemechanisms,becomes
impaired[39][40].Poorhypoglycemiaawarenessinpeoplewithdiabetescanbedangerousbecauseaffectedindividualsdonot
realizethattheirbloodglucoseislow,andextremeanduncorrectedhypoglycemiamayleadtounconsciousnessandeven
death.
Inpeoplewithtype1diabetes,pulsedarterialspinlabelingandBOLDfMRIstudieshavedemonstratedincreasedbloodflowin
severalbrainregionssuchasthehypothalamus,brainstem,anteriorcingulatedcortex,uncus,andputamenduringperiodsof
mildhypoglycemia,whichmaysuggestthatthesestructuresareespeciallysensitivetoevensmallbloodglucosechanges[41]
[42].Thus,evensmallacuteglycemicchangesmaybeofclinicalimportance.
ExposuretoRecurrentHypoglycemia
Theeffectsofrecurrenthypoglycemiaoncognitionaresubjecttodebate.Multiplehypoglycemicepisodesmaybeexperienced
inthosewithtype1diabeteswhoundergointensiveinsulintherapy.Repeatedhypoglycemiainbothtype1andtype2diabetes
hasbeenshowntocauseimpairedhypoglycemiaawareness,andanalterationoftheglycemicthresholdsthatthebrainis
usedto[43].Asmentionedearlier,thispoorawarenessofhypoglycemiamayleadtopoortreatmentadjustmentpractices,
whichcouldthenleadtounconsciousnessordeathasthehypoglycemiabecomesmoresevere.
Analysisofthe18yearDCCTtrialshowednosignificantdeclineincognitioninpersonswithtype1diabetes,despitehigh
frequencyofhypoglycemiccomaand/orseizures[44].Theremay,however,beadaptivechangesthatunderliereducedcerebral
efficiencyinpeoplewithType1diabetes.PeoplewithType1diabeteshavebeenshowntohaveincreasedbrainactivationin
severalregions(bilateralfrontalandparietalcortices,insula,thalamus,andcerebellum)duringperiodsofhypoglycemia.Higher
HbA1cwasassociatedwithloweractivationintherightparahippocampalgyrusandamygdalaaswell,whichcouldindicate
compensatoryrecruitment.Thus,whilecognitivedifferencesmaynotbeevidentinthosewithahistoryofhypoglycemia,such
peoplemayrequireahigherlevelofbrainactivationtomaintainthesamelevelofcognitivefunctionastheirpeerswithout
diabetes[45].
Certainnegativeeffectsofrecurrenthypoglycemiahavebeenuncoveredusingneuroimagingtechniques.VoxelBased
Morphometry(VBM)studiessuggestthatahigherselfreportedfrequencyofseverehypoglycemiceventswereassociatedwith
graymatterdensitylosses,particularlyintheleftcerebrellarposteriorlobeandthelimbicunci[46].Thereisevidencethatthe
cerebellumisinvolvedinhigherexecutivefunctioning,language,andaffect.Insulttothisregionmayresponsibleforseveral
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cognitivedeficits[47].
Personswithtype2diabetesdonotundergorepeatedepisodesofhypoglycemiaasfrequentlyasthosewithtype1diabetes
[48].Thereissomedebateastotheeffectsofrecurrenthypoglycemiaonthedevelopmentofcognitivedysfunctionand
dementiainthosewithtype2diabetes.Studiesoffercontradictoryevidenceregardingtherelationshipbetweenhypoglycemic
episodesandlaterdementiadevelopment[49][50][51].Furtherresearchisneededtohelpelucidatethelongtermeffectsof
recurrenthypoglycemicepisodesoncognition,mood,anddementiadevelopment.
References
1.^McCrimmonRJ,RyanCM,FrierBM.Diabetesandcognitivedysfunction.Lancet.
2.^ConnerTM,FlesnerGurleyKR,BarnerJC.Hyperglycemiainthehospital
3.^LevetanCS,MageeMF.Hospitalmanagementofdiabetes.EndocrinolMe
4.^UmpierrezGE,IsaacsSD,BazarganN,YouX,ThalerLM,KitabchiAE.Hyperglycemia:anindependentmarkerofin
hospitalmortalityinpatientswithundiagnoseddiabetes.JClinEndocrinolMetab200287:97882.
5.^TanHK,FlanaganD.Theimpactofhypoglycaemiaonpatientsadmittedtohospitalwithmedicalemergencies.Diabet
Med.2013May30(5):57480.
6.^NirantharakumarK,MarshallT,KennedyA,NarendranP,HemmingK,ColemanJJ.Hypoglycaemiaisassociatedwith
increasedlengthofstayandmortalityinpeoplewithdiabeteswhoarehospitalized.DiabetMed.2012Dec29(12):e4458.
7.^PaisI,HallschmidM,JauchCharaK,SchmidSM,OltmannsKM,PetersA,BornJ,SchultesB.Moodandcognitive
functionsduringacuteeuglycaemiaandmildhyperglycaemiaintype2diabeticpatients.ExpClinEndocrinolDiabetes.
2007Jan115(1):426.
8.^SommerfieldAJ,DearyIJ,FrierBM.Acutehyperglycemiaaltersmoodstateandimpairscognitiveperformancein
peoplewithtype2diabetes.DiabetesCare.2004Oct27(10):233540.
9.^HermannsS,ScheffC,KulzerB,WeyersP,PauliP,KubiakT,HaakT.Assoicationofglucoselevelsandglucose
variabilitywithmoodintype1diabetespatients.Diabetologia.2007March50930933.
10.^PapanikolaouY,PalmerH,BinnsMA,JenkinsDJ,GreenwoodCE.Bettercognitiveperformancefollowingalow
glycaemicindexcomparedwithahighglycaemicindexcarbohydratemealinadultswithtype2diabetes.Diabetologia.
2006May49(5):85562.Epub2006Mar1
11.^SeegerR,LehmannR.[Drivingabilityandfitnesstodriveinpeoplewithdiabetesmellitus].TherUmsch.2011
May68(5):24952.
12.^NorthamEA,RankinsD,LinA,etal.Centralnervoussystemfunctioninyouthwithtype1diabetes12yearsafter
diseaseonset.DiabetesCare200932::445450.
13.^CoxDJ,KovatchevBP,GonderFrederickLAetal,etalRelationshipsbetweenhyperglycaemiaandcognitive
performanceamongadultswithtype1andtype2diabetes.DiabetesCare200528::7177.
14.^MezukB,EatonWW,AlbrechtS,GoldenSH.Depressionandtype2diabetesover
15.^RustadJK,MusselmanDL,NemeroffCB.Therelationshipofdepressionanddiabetes:pathophysiologicaland
http://www.diapedia.org/associateddisorders/61047161570/effectsofglucoseonthebrain 4/8
6/10/2016 EffectsofglucoseonthebrainAssociateddisordersDiapedia,TheLivingTextbookofDiabetes
treatmentimplications.Psychoneuroendocrinology.2011Oct36(9):127686.
16.^BrandsAM,BiesselsGJ,deHaanEH,KappelleLJ,KesselsRP.Theeffectsof
17.^RavonaSpringerR,MoshierE,SchmeidlerJ,GodboldJ,AkrivosJ,RappM,GrossmanHT,WysockiM,Silverman
JM,HaroutunianV,BeeriMS.Changesinglycemiccontrolareassociatedwithchangesincognitioninnondiabetic
elderly.JAlzheimersDis.201230(2):299309.
18.^SanzCM,RuidavetsJB,BongardV,MarquiJC,HanaireH,FerriresJ,AndrieuS.RelationshipBetweenMarkersof
InsulinResistance,MarkersofAdiposity,HbA1c,andCognitiveFunctionsinaMiddleAgedPopulationBasedSample:
theMONALISAStudy.DiabetesCare.2013Jun36(6):151221.
19.^GreggEW,YaffeK,CauleyJA,RolkaDB,BlackwellTL,NarayanKM,CummingsSR.Isdiabetesassociatedwith
cognitiveimpairmentandcognitivedeclineamongolderwomen?StudyofOsteoporoticFracturesResearchGroup.Arch
InternMed.2000Jan24160(2):17480.PubMedPMID:106477
20.^FolsomAR,RasmussenML,ChamblessLE,HowardG,CooperLS,SchmidtMI,HeissG.Prospectiveassociationsof
fastinginsulin,bodyfatdistribution,anddiabeteswithriskofischemicstroke.TheAtherosclerosisRiskinCommunities
21.^SelvinE,BolenS,YehHC,WileyC,WilsonLM,MarinopoulosSS,FeldmanL,
22.^WhitmerRA.Type2diabetesandriskofcognitiveimpairmentanddementia.CurrNeurolNeurosciRep.2007
Sep7(5):37380.Review.
23.^LastD,AlsopDC,AbduljalilAM,MarquisRP,deBazelaireC,HuK,Cavallerano
24.^vanHartenB,deLeeuwFE,WeinsteinHC,ScheltensP,BiesselsGJ.Brainimaginginpatientswithdiabetes:a
systematicreview.DiabetesCare.2006Nov29(11):253948.Review.
25.^GoldSM,DziobekI,SweatV,TirsiA,RogersK,BruehlH,TsuiW,RichardsonS,JavierE,ConvitA.Hippocampal
damageandmemoryimpairmentsaspossibleearlybraincomplicationsoftype2diabetes.Diabetologia.2007
Apr50(4):7119.Epub2007Feb14.
26.^McCrimmonRJ,RyanCM,FrierBM.Diabetesandcognitivedysfunction.Lancet.
27.^AuerRN.Hypoglycemicbraindamage.MetabBrainDis200419:16975.
28.^CoxDJ,GonderFrederickLA,KovatchevBP,JulianDM,ClarkeWL.Progressivehypoglycemiasimpactondriving
simulationperformance:occurrence,awarenessandcorrection.DiabetesCare200023:16370.
29.^RyanC,GurtuncaN,BeckerD.Hypoglycemia:acomplicationofdiabetestherapyinchildren.PediatrClinNorthAm.
2005Dec52(6):170533.
30.^CampbellLK,GonderFrederickLA,BroshekDK,KovatchevBP,AndersonS,ClarkeWL,CoxDJ.Neurocognitive
DifferencesBetweenDriverswithType1DiabeteswithandwithoutaRecentHistoryofRecurrentDrivingMishaps.IntJ
DiabetesMellit.2010Aug12(2):7377
31.^StrachanMWJ,DearyIJ,EwingFME,FrierBM.Recoveryofcognitivefunctionandmoodafterseverehypoglycemiain
adultswithinsulintreateddiabetes.DiabetesCare.200023:305312
32.^ZammittNN,WarrenRE,DearyIJ,FrierBM.Delayedrecoveryofcognitivefunctionfollowinghypoglycemiainadults
http://www.diapedia.org/associateddisorders/61047161570/effectsofglucoseonthebrain 5/8
6/10/2016 EffectsofglucoseonthebrainAssociateddisordersDiapedia,TheLivingTextbookofDiabetes
withtype1diabetes.Diabetes.200857:732736
33.^GoldAE,MacLeodKM,FrierBM,DearyIJ.Changesinmoodduringacutehypoglycemiainhealthyparticipants.JPers
SocPsychol.1995Mar68(3):498504.
34.^McAulayV,DearyIJ,SommerfieldAJ,MatthewsG,FrierBM.Effectsofacutehypoglycemiaonmotivationand
cognitiveinterferenceinpeoplewithtype1diabetes.JClinPsychopharmacol.2006Apr26(2):14351.
35.^AuerRN.Hypoglycemicbraindamage.MetabBrainDis200419:16975.
36.^HellerSR,CryerPE.Reducedneuroendocrineandsymptomaticresponsestosubsequenthypoglycemiaafter1
episodeofhypoglycemiainnondiabetichumans.Diabetes.1991Feb40(2):2236.
37.^GersteinHC,MillerME,ByingtonRP,GoffDCJr,BiggerJT,BuseJB,CushmanWC,GenuthS,IsmailBeigiF,Grimm
RHJr,ProbstfieldJL,SimonsMortonDG,FriedewaldWT.Effectsofintensiveglucoseloweringintype2diabetes.N
EnglJMed.2008Jun12358(24):254559.
38.^FanelliCG,EpifanoL,RambottiAM,PampanelliS,DiVincenzoA,ModarelliF,LeporeM,AnnibaleB,CiofettaM,
BottiniP,etal.Meticulouspreventionofhypoglycemianormalizestheglycemicthresholdsandmagnitudeofmostof
39.^McCrimmonRJ.UpdateintheCNSresponsetohypoglycemia.JClinEndocrinolMetab.2012Jan97(1):18.doi:
10.1210/jc.20111927.Review.
40.^CryerPE.BantingLecture.Hypoglycemia:thelimitingfactorinthemanagementofIDDM.Diabetes.1994
Nov43(11):137889.Review.
41.^PageKA,WilliamsonA,YuN,McNayEC,DzuiraJ,McCrimmonRJ,SherwinRS.Mediumchainfattyacidsimprove
cognitivefunctioninintensivelytreatedtype1diabeticpatientsandsupportinvitrosynaptictransmissionduringacute
hypoglycemia.Diabetes.2009May58(5):123744.
42.^McCrimmonRJ.UpdateintheCNSresponsetohypoglycemia.JClinEndocrinolMetab.2012Jan97(1):18.doi:
10.1210/jc.20111927.Review.
43.^McCrimmonRJ,RyanCM,FrierBM.Diabetesandcognitivedysfunction.Lancet.
44.^JacobsonAM,MusenG,RyanCM,SilversN,ClearyP,WaberskiB,BurwoodA,WeingerK,BaylessM,DahmsW,
HarthJ.Longtermeffectofdiabetesanditstreatmentoncognitivefunction.NEnglJMed.2007May3356(18):184252.
Erratumin:NEnglJMed.2009Nov5361(19):1914.
45.^BoloNR,MusenG,JacobsonAM,WeingerK,McCartneyRL,FloresV,RenshawPF,SimonsonDC.Brainactivation
duringworkingmemoryisalteredinpatientswithtype1diabetesduringhypoglycemia.Diabetes.2011Dec60(12):3256
64.
46.^MusenG,LyooIK,SparksCR,WeingerK,HwangJ,RyanCM,JimersonDC,HennenJ,RenshawPF,JacobsonAM.
Effectsoftype1diabetesongraymatterdensityasmeasuredbyvoxelbasedmorphometry.Diabetes.2006
Feb55(2):32633.
47.^SchmahmannJD,ShermanJC.Thecerebellarcognitiveaffectivesyndrome.Brain.1998Apr121(Pt4):56179.
48.^HellerSR,ChoudharyP,DaviesC,etal.Riskofhypoglycaemiaintypes1and2diabetes:Effectsoftreatment
http://www.diapedia.org/associateddisorders/61047161570/effectsofglucoseonthebrain 6/8
6/10/2016 EffectsofglucoseonthebrainAssociateddisordersDiapedia,TheLivingTextbookofDiabetes
modalitiesandtheirduration.Diabetologia200750:11401147
49.^ReijmerYD,vandenBergE,RuisC,KappelleLJ,BiesselsGJ.Cognitivedysfunctioninpatientswithtype2diabetes.
DiabetesMetabResRev.2010Oct26(7):50719.
50.^WhitmerRA,KarterAJ,YaffeK,QuesenberryJ,SelbyJV.Hypoglycemicepisodesandriskofdementiainolder
patientswithtype2diabetesmellitus.JAmMedAssoc2009301:15651572.
51.^BruceDG,DavisWA,CaseyGP,etal.Severehypoglycaemiaandcognitiveimpairmentinolderpatientswithdiabetes:
TheFremantleDiabetesStudy.Diabetologia200952:18081815.
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